Alignment for Progress: A National Strategy for Mental Health and Substance Use Disorders
It’s time for a meaningful national conversation about mental health and substance use care. We must remove the barriers to equitable and available coverage for these conditions so people can get the help they need.
Welcome To The National Strategy
Want to understand more about the importance of building a National Strategy for Mental Health & Substance Use Disorders?
How Content Is Organized and How Best to Search/Sort the Recommendations
The National Strategy recommendations are organized by category, with impacted populations and topical areas providing additional nuance and the ability to narrow a search. We have also included the option to search recommendations by the relevant House and Senate committees of jurisdiction.
Recommendation Selection Methodologies and Criteria
After conducting a thorough review of the federal policy landscape, The Kennedy Forum team created this first-of-its-kind compilation of policy recommendations needed to transform our mental health and substance use systems. The recommendations have been sourced and vetted from numerous organizations, advocates, and experts across the country in order to capture a robust set of recommendations for lawmakers and federal agencies to act on.
All National Strategy Recommendations
These featured recommendations are highlighted based on their importance in beginning the national movement towards better care for everyone.
Pass the Supporting Farm Workers’ Mental Health Act
Congress should pass the Supporting Farm Workers’ Mental Health Act.
In 2008, the Farm and Ranch Stress Assistance Network was created as a support network with resources for farmers and ranchers. Farmworkers - the increasing population of workers that support farmers with labor - were not included in the original population eligible for care. According to a recent study, almost 20% of farm workers reported symptoms of anxiety and 14% reported feeling depressed. The Farm Workers’ Mental Health Act would include farmworkers as an eligible population and make peer-to-peer care an eligible grant activity.
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Pass the Stop Institutional Child Abuse Act (SICAA)
Congress should pass the Stop Institutional Child Abuse Act (SICAA).
In the United States, as many as 200,000 children are placed in residential treatment facilities each year [1]. Currently, residential treatment facilities for adolescents are largely unregulated, which has created a muddled system with a spectrum of programs that can be life-saving on one end, and abusive on the other. Congress should pass the Stop Institutional Abuse Act to initiate the process of regulating residential treatment for adolescents, including data collection, implementation of best practices, use of evidence-based risk assessment tools, and regular reporting to the federal government [2]. Importantly, SICAA directs the National Academies of Sciences, Engineering, and Medicine to study the use of seclusion, restraints, and restrictive and punitive interventions during treatment [3].
Additionally, Congress should authorize the Department of Justice to investigate and prosecute SICAA violations by residential treatment facilities and their affiliates, such as transport services, providing criminal-level sanctions for violations.
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Pass the Rehabilitation and Recovery During Incarceration Act
To give incarcerated people some coverage for mental health care under Medicaid, Congress should pass the Rehabilitation and Recovery During Incarceration Act.
The Medicaid Inmate Exclusion policy currently excludes both those who are awaiting trial and incarcerated people from Medicaid coverage, regardless of prior eligibility. It has been proven that without medically necessary mental health and addiction treatment, recidivism among these populations increases [1].
The Rehabilitation and Recovery During Incarceration Act would give states the ability to allow Medicaid and CHIP to cover mental health and substance use for eligible inmates. According to the Prison Policy Initiative, 40% of the prison and jail population in the United States has a diagnosed mental illness. A large portion of people living in prisons and jails have not been screened for mental illness or substance use disorders and 66% of people in federal prison report not receiving mental health care during incarceration [1]. It is apparent that people who are incarcerated experience “serious psychological distress” due to their incarceration [1]. Congress should pass the Rehabilitation and Recovery During Incarceration Act to get incarcerated people the necessary mental health and addiction treatment they deserve, reduce recidivism, and drive up healthcare in the prison setting.
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Pass the CAREERS Act to support VA clinicians
Congress should pass the VA Clinician Appreciation, Recruitment, Education, Expansion, and Retention Support (CAREERS) Act.
Workforce challenges are persistent across hospitals and other health-based service providers, including the Department of Veterans Affairs; these challenges require creative and sustained solutions to recruit and retain healthcare professionals to serve one of the largest and most vulnerable populations: veterans. The VA Clinician Appreciation, Recruitment, Education, Expansion, and Retention Support (CAREERS) Act would help alleviate these workforce challenges by improving reimbursement eligibility for continuing education, providing support for licensure exam costs, and revising the pay system for physicians. The CAREERS Act would help address vacancies in the VA hospital system with transparency and timeliness. We cannot let veterans continue to be underserved in the VA hospital system. Congress should pass the CAREERS Act to provide needed resources to VA health providers.
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Pass the Behavioral Health Information Technology (BHIT) Coordination Act
Congress should pass the Behavioral Health Information Technology (BHIT) Coordination Act.
Information technology (IT) has become increasingly important in healthcare settings, especially for care integration and provider-patient communications. Mental health and substance use disorder care has previously been left out of funding opportunities to advance IT in health care. The Behavioral Health Information (BHIT) Coordination Act would provide grant funding to finance the expansion of behavioral health IT, have SAMHSA develop behavioral health IT standards, and direct SAMHSA, CMS, and ONC to release joint guidance to states on how they can promote adoption of EHR technology to behavioral health providers. Mental health and substance use disorder care must be integrated into all health care IT for truly integrated care across providers. Physical health care providers should be able to see the behavioral health history of their patients and vice-versa. Congress should pass the BHIT Coordination Act so that mental health and substance use care is included in all health care IT moving forward.
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Pass the Autism CARES Act of 2024
Congress should pass the Autism CARES Act of 2024.
A host of research indicates that the majority of people living with Autism Spectrum Disorder (ASD) have at least one concurring mental health condition. Mental illnesses also become more apparent as people with ASD age but are often found early in children and teens with the proper screening. Traditionally, autism research has had gaps that are not inclusive of concurrent mental illnesses and suicidal or self-harmful behaviors.[2] To better understand and treat concurrent mental illnesses in people with ASD, critical funding and resources are needed for research. The primary source of grant funding for research, services, and training for autism is through the Autism CARES Act of 2019. In 2024, the important law was enhanced in the form of a new bill with important updates and renewal of funding before the original 2019 funding expired. Some important changes include support for the study of autism and aging and research on expanding the number of pediatricians trained to treat children with autism. Importantly, it directs the Director of NIH to take a more inclusive approach to research about autism.[1]
The Autism CARES Act of 2019 has been transformational, and before its existence, there were virtually no public policy efforts specifically to help people with autism.[3] The Autism CARES Act established the hugely important Interagency Autism Coordinating Committee (IACC) within the Department of Health and Human Services, a federal advisory committee that studies and advises the Secretary of HHS on Autism Spectrum Disorder. The IACC has taken a groundbreaking approach to autism research, that includes the intersection of gender and race in outcomes for people with autism. Congress should pass the Autism CARES Act of 2024 so that the important and timely research and funding for autism continues in the federal government.